Implementing Effective COPD Telerehabilitation Must Involve Staff, Study Finds

The study included semi-structured individual and focus group interviews, which were conducted with 25 health professionals who worked with conventional COPD rehabilitation or TR. The interviews were based on the 14 domains of the Theoretical Domains Framework (TDR), which supports the identification of barriers and enablers in the implementation of heath interventions. The interviews were audio-taped and transcribed and the TDF was used as a coding framework during the analysis.

Telerehabilitation (TR), defined as telecare that involves supervised online exercise sessions for patients with chronic obstructive pulmonary disease (COPD), is beneficial for symptom relief, physical function, and quality of life. A recent study found that specific attention toward the involvement of health professionals in the decision process combined with education and skill training is essential to support the successful implementation of TR.

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“Often identified barriers are lack of organizational support and resources, telecare experienced as threatening due to changes in work routines, workload and skills set, as well as equipment reliability,” explained the authors. “Furthermore, the health care professionals’ overall attitude toward telecare was identified as essential to the adaption and acceptance of the interventions. Therefore, overcoming these potential barriers is key to a successful implementation of telecare and an important step to support effective telecare interventions.”

Following the interviews, the researchers were able to identify 6 predominant domains that are essential for understanding the enablers and barriers of TR from a health professional perspective. The domains included:

1. Skills
2. Professional role and identity
3. Beliefs about capabilities
4. Beliefs about consequences
5. Environmental context and resources
6. Social Influences

“Our study design enabled us to relate attitudes from health care professionals with and without COPD tele experience,” the authors noted. “We found that the teleexperienced group had fewer barriers and more enablers regarding TR than the no-tele-experienced group. In addition, the no-tele-experienced group reported barriers in training patients online because of the absence of training facilities in the patient’s home. This was not a barrier to the experienced group.”

Health professionals can either enable or block the the implementation of TR, the study indicated. The researchers noted that TR introduces new work tasks and new ways for health professionals to communicate and exercise with patients, which therefore influences their professional role and self-perceived capability.

The researchers concluded specific attention toward the involvement of the health professionals in the decision process combined with sufficient education and skill training is important for implementing TR in clinical practice. Further research is needed in this area in order to get a better understanding of TR from a staff perspective.

Reference

Damhus CS, Emme C, Hansen H. Barriers and enablers of COPD telerehabilitation — a frontline staff perspective. [published online August 17, 2018]. Int J Chron Obstruct Pulmon Dis. doi 10.2147/COPD.S167501.